Lecture 5

Question 1

what is the vitreous made out of?

Answer 1

98% water with collagenous framework

Question 2

how much of the total ocular volume is the vitreous?

Answer 2

about 75% - higher volume in myopic eyes

Question 3

what are “floaters”?

Answer 3

any area of the vitreous that is dense enough to be detected by the patient or seen during DO

Question 4

what is the most common entoptic phenomenon reported by patients?

Answer 4

floaters (most common reason for office visits)

Question 5

where are the 4 vitreoretinal attachments?

Answer 5

vitreous base, around optic disc margins, around macula, and around peripheral retinal blood vessels

Question 6

where is the strongest point of attachment for the vitreous?

Answer 6

vitreous base = 3-4mm wide zone straddling the ora errata

Question 7

what is the vitreous attached to specifically in the retina in all areas?

Answer 7

the ILM (inner limiting membrane)

Question 8

where are posterior vitreous detachments most likely to occur?

Answer 8

peripapillary = around the optic nerve (progressively weakens with age)

Question 9

what are 3 ways you can view the vitreous?

Answer 9

DO (red reflex), fundus biomicroscopy before lens, and BIO (red reflex)

Question 10

why is a dilated exam important?

Answer 10

to examine the peripheral retina in search for rhegmatogenous conditions (identifies risk for RD)

Question 11

what is synchysis?

Answer 11

vitreous slowly undergoing liquefaction (slowly degrades) = seen as empty

Question 12

what is syneresis?

Answer 12

shrinkage of the vitreous - secondary to separation of liquids and solids

Question 13

which patients are more likely to get a PVD?

Answer 13

high myopia, post-surgical cataracts, trauma, and >40 y/o

Question 14

what are some symptoms of a PVD?

Answer 14

floaters and may have flashes - flashes are due to traction stimulating photoreceptors

Question 15

what are some signs of a PVD?

Answer 15

annular ring (Weiss’ Ring) in front of ONH, retinal hemorrhage and/or vitreous hemorrhage

Question 16

what is Shaffer’s sign or tobacco dusting?

Answer 16

the presence of pigment granules in anterior vitreous and Berger’s space

Question 17

why is it important to look for Shaffer’s sign if the patient reported flashes and floaters?

Answer 17

98% will have a retinal detachment and 60% will have a retinal break (hole or tear)

Question 18

when looking at Shaffer’s sign, you use a red-free filter, what should happen if the granules are RBCs?

Answer 18

they will disappear

Question 19

what is asteroid hyalosis?

Answer 19

common benign finding in >50 y/o (90% unilateral) = yellow-white spheres of calcium lipids adhering to vitreous framework

Question 20

what does asteroid hyalosis look like?

Answer 20

seen as small yellow-white round opacities floating within vitreous - move freely in synchisis (snow globe)

Question 21

what is asteroid hyalosis associated with?

Answer 21

aging collagen within vitreous and depolymerization of hyaluronic acid

Question 22

what are 3 symptoms for a retinal detachment?

Answer 22

floaters, photopsia (flashes) and a visual field defect

Question 23

what are some signs of a retinal detachment?

Answer 23

variable acuities, APD, lower IOP in affected eye, shaffer’s sign, retinal breaks, large holes or tears